Provider Demographics
NPI:1356062384
Name:AUTISM UNCHAINED LLC
Entity type:Organization
Organization Name:AUTISM UNCHAINED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:302-540-5363
Mailing Address - Street 1:347 RICEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JAVA
Mailing Address - State:VA
Mailing Address - Zip Code:24565-4101
Mailing Address - Country:US
Mailing Address - Phone:434-770-0049
Mailing Address - Fax:
Practice Address - Street 1:347 RICEVILLE RD
Practice Address - Street 2:
Practice Address - City:JAVA
Practice Address - State:VA
Practice Address - Zip Code:24565-4101
Practice Address - Country:US
Practice Address - Phone:434-770-0049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty